Prison

Sunday, 19 March 2017

Our dysfunctional prisons are so deeply in crisis that the usual tabloid topics – violence, suicides, drug taking, illicit mobile phones – seem to have been exhausted. In the past few days the focus has been on jail fires, which appear to have become something of an everyday occurrence.

In the real world – that is outside prison walls – arson is considered to be a very serious offence, threatening as it does not only property but also human lives. The maximum penalty for deliberate fire-starting is life imprisonment, even if no one has been killed in the resulting conflagration.

Not much to burn

During my time inside I met a handful of prisoners who had been given Indeterminate Public Protection (IPP) sentences for this very offence. A few were fairly ordinary blokes who had been involved in ‘domestic’ dramas and had then vented their frustration by burning down the family home. One had actually set fire to a police station.

Mercifully there were no casualties in any of these cases, but arson is clearly one of those offences that gives rise to a judge’s suspicion that the arsonist is liable to do it again in the future, hence the handing down of draconian sentences of a notional 99 years (most of the arsonist IPPs had a minimum tariff of a couple of years). As far as I could tell, none of those inmates I met seemed to be serial fire raisers, just average joes who had poor anger management and who had made very bad decisions in a personal crisis.

Prison fires on the other hand rarely carry serious penalties. In fact the practice now seems to be fairly routine. According to recent media reports, Ministry of Justice (MOJ) figures indicate that there were 2,580 such incidents inside our prisons during 2016. A quick bit of mental arithmetic and that equates to an average of 50 fires each week. According to a BBC report, the MOJ claims that most of these cases were “fairly minor”.

Fire during HMP Birmingham riot

What is more revealing is that some of the worse affected prisons are those that have seen serious disturbances and other types of violence recently, including HMP Birmingham (G4S) and Swaleside. According to MOJ figures, HMP Birmingham recorded 82 fires last year, while Swaleside managed to rack up 73. Other troubled establishments included HMP Nottingham (78) and Serco run HMP Doncaster (75).

Of course, some of these incidents are likely to have been accidents (down to careless smokers or electrical faults), while others occurred in the context of wider protests by prisoners. For a minority, setting fire to a hated prison is the equivalent of an act of violence against ‘the system’. Nevertheless, the overall total has more than doubled compared to the average annual recorded incidents during the period 2005 to 2013. In fact, each year since 2013 has seen a substantial rise. It does seem that as our troubled prisons have become more and more dangerous and dysfunctional, so the incidence of setting fires has risen.

Plenty of combustible items here

Almost all deliberate fires in prisons occur in cells. Although most furnishings are fire-retardant (such as mattresses, blankets and sheets), other commonly available items such as WC paper, clothing and newspapers can go up a treat, especially if assisted by the contents of disposable cigarette lighters which are available from the canteen in those prisons that haven’t yet banned smoking. Given that an estimated 80 percent of adult prisoners smoke, there is plenty of scope for starting a blaze.

The reasons why a minority of inmates decide to burn what few possessions they have are many and varied. Some prisoners undoubtedly get bored and setting a fire is one of the few things (along with causing a flood) that can’t just be ignored by wing staff. No matter what prison officers are doing, they have to respond to smoke pouring out from under a locked cell door. The prisoner gets attention and will be asked by a manager or governor grade what his particular grievances are. Like self-harming, arson produces quick results for frustrated men who may be locked behind bars for 22 or 23 hours each day.

Other prisoners who light fires may be experiencing from a serious mental illness or could be desperate for a transfer out of an establishment in which they are being bullied or victimised. In such cases starting a small cell blaze can be a way of fast-tracking a move either to the safety of the Block (segregation unit) or to another prison.

Fire hose port

Every cell door features a fire hose port that can be unscrewed by staff using a special tool. This enables them to douse the cell with water without opening the door, although in practice the top priority is usually to extract the prisoner(s) from the cell to avoid having to deal with the dangers of smoke inhalation. Very few, if any, prisoners actually intend to commit suicide by self-immolation, so there is rarely a serious casualty as a result of cell fires.

Once available paperwork and wooden furniture has been consumed, there is little chance of the concrete fabric of the cell being damaged. As with most fires, smoke is the actual danger to human health.

At troubled HMP Birmingham a recent cell fire threatened to cause much more widespread disruption because of the design of the ventilation system. When one cell was set on fire, the smoke started filling up the vent and then seeped through into other cells on the wing. Imagine the terror of being confined in a tiny concrete box where windows don’t actually open, as smoke pours through a vent high up on the wall. Fortunately this incident was dealt with without having to evacuate the wing, yet the risks – especially to prisoners who suffer from serious breathing problems – are very real.

HMP Ford burning in January 2011

Prison roof fires are potentially even more dangerous. Back in January 2011 whole prison blocks were torched at HMP Ford in Sussex, while in July 2015 a prisoner managed to set fire to one of the prison’s flat roofs by throwing burning toilet paper up from his cell window. Older jails, particularly open prisons located in former army or air force barracks, still contain a substantial amount of seasoned wood. That’s one reason why very few open establishments are willing to accommodate convicted arsonists who have made it to Cat-D status.

Earlier this month HMP Guys Marsh in Dorset had to be partially evacuated after a protesting inmate got onto the roof, stripped off his clothing and used the garments to set fire to a sizeable section of the wing roof causing serious damage. It’s worth noting that this is a troubled prison where prison inspectors found in 2014 that staff had “all but lost control”.

It seems clear that deliberate arson is an increasingly common feature of prisons in crisis. Prisoners are rarely prosecuted for lighting small fires unless substantial amounts of structural damage have resulted. Most just end up cooling their heels in the Block for some days.

Fire tender at HMP Birmingham

The much greater risk from fire comes when there is serious disorder in a prison and staff members have withdrawn from the affected wings and landings. Full-scale riots often involve the burning of documents from ransacked offices – as happened in December at HMP Birmingham – or cell furniture that is often piled up in the middle of wings to form makeshift barricades. Setting fire to a prison is an effective way of ensuring that it remains out of action for months. It’s worth noting that the most severely damaged wings at HMP Birmingham are still under repair three months on.

Acts of arson are symptoms of the much wider crisis across our prisons. Staff control in a whole list of jails – particularly Cat-B locals – is often tenuous and could be lost at any time, without warning. Prisons that are now routinely short-staffed are particularly vulnerable.

Virtually every prison outside the high security estate runs on a day-to-day basis only because a sufficient number of inmates are willing to cooperate in their own incarceration. There is now clear evidence that this tacit agreement is breaking down on an almost daily basis and the number of violent incidents is soaring. The destruction of wings at HMP Birmingham should be a warning to us all of what lies ahead unless the prison crisis is taken much more seriously.

Monday, 6 March 2017

One of the issues that often causes people genuine concern in the modern age is the question of security of their personal data, especially confidential medical information. In recent years there has been a lively debate over proposals for data sharing between the NHS and other agencies, yet when it comes to prisons and prisoners there seems to be something of a ‘black hole’ where elementary patient rights are ignored.

Does it go beyond the door?

The specific issue of professional confidentiality in our prisons seems to be very poorly developed or understood. In theory, at least, prisoners are supposed to be provided with the same level of patient care and treatment as is available to all other users of the NHS, yet we know from successive reports from HM Coroners’ inquests that, sadly, on occasion there have been some very serious shortcomings when individual prisoners have died in custody. I am personally aware of one case in which the healthcare manager in a specific prison resigned following a particularly damning inquest verdict that highlighted medical neglect.

Again – in theory – prisoners’ interactions with professionals working in prisons, including doctors, nurses and psychiatric staff, should be treated in the same way as in the local health centre or clinic in the community. While certain types of information sharing are permissible (particularly to protect the vulnerable or children at risk) I think it is fair to say that most of us would take a very dim view of a local GP or nurse who chose to write a sensational ‘treat and tell’ book exposing our confidential medical information to the wider world, or even in a tabloid newspaper, especially when the patients are identified by their real names.

HMP Altcourse - a G4S prison

I was reminded of this today when I saw that a former psychiatric nurse who had worked at Liverpool’s HMP Altcourse – and who states that she has 38 years of clinical experience – has published a book about her time working at this private prison managed by G4S. The book has since been picked up by a leading tabloid and, in an article, very specific details concerning this nurse’s professional interactions with one particularly notorious prisoner are explored.

Reading the article – although not the book (which I am also not naming as I don’t feel I should be giving it the oxygen of further publicity) – I was struck with a sense that this is clinical information that really shouldn’t be in the public domain. This is not only because of the potential impact on the prisoner concerned, but also because of the likelihood that the newspaper coverage will come to the attention of the victim’s family. Details of a particularly grisly crime, including photos of both the prisoner and the victim, are included in the article.

Healthcare: behind bars

I think it is also important to note that this does not seem to be a scientific study that might be of use to criminologists or forensic psychiatrists, but it is rather an exploitative and sensational book that appears to have been self-published for sale online. To be honest, I was shocked that a qualified health professional who claims to have 38 years of experience couldn’t see the potential conflicts of interest, let alone a probable violation of a duty of care to a former patient who is portrayed as particularly vulnerable.

There would be serious ethical issues involved even if every prisoner mentioned in such a publication had given free consent, yet I very much doubt that this was obtained, let alone permission from the families of victims involved in specific crimes. Perhaps if names had been changed or anonymised, the potential breaches of trust might have been largely avoided, yet it is clear that real names and specific offences are being described in gory detail.

In my view the publication of this book – and others like it – are a serious indictment both of our present prison system and of the professional bodies that are supposed to regulate staff members that provide medical and clinical care to prisoners. I believe strongly that this duty of care and confidentiality should not cease when either a prisoner is released or a healthcare professional retires. Surely this should be reflected in staff employment contracts?

Asking the right questions

The potential pitfalls should be there for all to see. If serving prisoners become aware that even a tiny minority of healthcare staff might be intent on publishing sensational books or giving interviews about them to the tabloid media then it is hard to see how any degree of trust can ever be established between patient and practitioner. What negative impact could that have on inmates seeking medical help in a time of crisis or illness? Should prisoners forfeit the right to basic levels of clinical confidentiality simply because they are in custody?

I recall that when I was in prison I was asked by a healthcare department to sign a document giving my permission for the sharing of my medical data with the prison authorities. I declined, not because I had anything I wished to conceal about my own health but because no one could explain why this access would be of any specific benefit to me. Indeed, I have come across cases where the sharing of prisoners’ medical information - for example a diagnosis of autism - has impacted negatively on indeterminate sentenced inmates’ chances of parole.

Let's talk about medical ethics

This sort of book merely feeds to public’s seemingly insatiable appetite for sensational information about prisoners who have committed notorious crimes. As always there is a wide gulf between wanting to know private information about others and the right to have access to it.

Surely at a time when we have a well documented mental health crisis across our prison estate, any publication that further undermines the very fragile relationship of trust between prisoners and prison medical staff should be a matter of concern for the Ministry of Justice and for the wider prison service. So, will any action be taken to be prevent unauthorised disclosure of clinical data? I’m afraid I’m not taking a deep breath.